Pinkeye: has anyone heard this?

[drloretta]

DD got pinkeye on Monday. Took her into the doc that afternoon. It wasn't her primary doc, but someone in the practice. She told us that a recent article said most pinkeye in kids is viral, so she recommended riding it out and keeping DD home all week until it cleared up. I'm feeling mommy guilt since I go back to work soon, so I said fine and took DD home.

By yesterday afternoon her eyes were way worse, so DH and I decided she should go to urgent care. The NP there looked at me like my doctor was nuts when I said she recommended no treatment. We got an Rx for eye drops immediately. DD's eyes are still red, but the gunk is gone as of this morning.

I can't find much in the literature about this trend of not treating. Has anyone else heard this?

[Ashley&Scott]

I have heard of not treating...however our pedi always treats it. DH & I have gotten pink eye a few times too & our family physician also treats with Rx eye drops.

[Brie]

I have spent an unfortunate amount of time with various optometrists and ophthalmologists over the last year and yes, that's possible. Pinkeye can be either viral, allergic, or bacterial. It's pretty hard to distinguish between the three, but IME, they tend to treat all pinkeye with antibiotics as a "well, it can't hurt, and if we're right, we'll know which type it is, and if we're not, it's narrowed down a bit" kind of thing.

[barefootcontessa]

I have heard something similar. Not that pink eye in children is mostly viral but rather than pink eye can be caused by a virus. Since treatment is topical I would think there is minimal downside to trying anbx, especially since her eyes would be vulnerable to bacterial infection anyway with all the irritation.

[mrssandro]

My doc immediately treats for this and supplied enough drops for the house. She told me to wait 24 hours after the treatment to return to school. The treatment was like magic and it went away overnight.

[anaps28]

My son had pink eye in the fall and the doc did mention the viral vs bacterial thing but she also said she couldn't be sure so she gave us eye drops anyway.

[drloretta]

The limited literature I found actually said most pediatric pinkeye is bacterial, so I'm glad she was seen by someone else. Thanks for sharing your experiences

[dexteroni]

Yes, I learned that from our old friend Lilly MD. I scoffed at the time, and made the "might as well try antibiotics" argument, but have since read the same thing. I don't know if it's mostly viral in kids or not - I kind of presume little kids are always teeming with bacteria - but that overall, most pinkeye is viral. Plus there's a big push not to overuse antibiotics now. I recently came off a two-week sinus infection without antibiotics, whereas in the past I'm sure they would have been prescribed first thing, just in case.

Regardless, I wouldn't be super psyched if my doctor was diagnosing me based on something she read in an article. Hopefully it was at least a medical journal study, and not an article in some random magazine (aka where I get my medical info, lol).

[elcjet]

Well, my Dr. acknowledges that some pink eyes are caused by viral infection, but he also will treat with antibiotic eye drops FIRST in case it's bacterial.  Thank goodness, too.....  Out of maybe 10 times my kids and I have had pink eye (3 times this year!), it has always been bacterial and responded very well to the drops.  Glad your urgent care got you some meds!

[bazinga]

I had pinkeye several years ago and was told it was viral and I could have drops if I wanted, but they wouldn't do anything. I went home to ride it out and the next day is was way worse. I had to go back in and get the drops. If I ever have to deal with it again, I am going with the drops right away!

[Deleted]

My pedi is a strong believer in that most pink eyes are viral or allergy related rather than bacterial.
He however hands out the antibiotic drops because he says it's impossible to tell the difference and who wants to be miserable esp. if it turns out to be bacterial and it could be taken care of stat. He claims the antibiotics in pink eye isn't a long course or all that strong due to being an area so he believes the antibiotic resistance isn't too big a deal in this case.

Sometimes he'll make people wait it out if it's not bad but he will call a script no problem if it's not better in a day or to.

So no your dr. isn't crazy, but kind of crazy you were just supposed to wait it out.

[Redpoppy]

DS had a weird case of conjunctivitis that wasn't pink eye and we ended up needing steroids to clear it up. The expensive no generic drops the ophthalmologist prescribed didn't work, then after a day of the steroid drops he was already much better.

Ours won't even have us come in for pinkeye. They will prescribe over the phone. With the above I had to insist to have him checked because I thought it wasn't typical and he wasn't very goopy. The doctor took one look and sent us immediately to the ophthalmologist. The pediatrician called them and they squeezed us in. She thought it was a foreign body but it was just conjunctivitis, the $250 case between 5 ophthalmologists visits in 3 weeks and then the pricey drops.

[Deleted]

Yes the most common cause of pink eye is adenovirus.

[Deleted]

May 14, 2014 9:10:55 GMT -5 drloretta said:

The limited literature I found actually said most pediatric pinkeye is bacterial, so I'm glad she was seen by someone else. Thanks for sharing your experiences

Hmm that's interesting as everything I've learned and read says that it's usually adenovirus.

I think most doctors these days will give drops though because "it won't hurt" to try the drops. Sometimes the infection would've cleared up on it's own in 2 days, sometimes the drops might speed up the process.

But I hope your daughter gets better soon!

[drloretta]

I know it's only anecdotal, but 18 hours after her initial dr visit, her eyes were a mess. Now 18 hours after drops, she's almost cleared up. And more importantly, can go back to school tomorrow ::happy dance::

[romigu]

May 14, 2014 8:50:58 GMT -5 Brie said:

I have spent an unfortunate amount of time with various optometrists and ophthalmologists over the last year and yes, that's possible. Pinkeye can be either viral, allergic, or bacterial. It's pretty hard to distinguish between the three, but IME, they tend to treat all pinkeye with antibiotics as a "well, it can't hurt, and if we're right, we'll know which type it is, and if we're not, it's narrowed down a bit" kind of thing.

This...and using antibiotic drops can create resistance so that bacteria living on your skin and not creating infection will not respond later to the same antibiotic. It could be viral and just be peaking - with my child, I get drops only if it persisting after 5-7 days

[rugbywife]

As PP have said, it can be 3 types, viral, allergic or bacterial. One year I had it 7 times in a matter of months. When I finally saw my family doctor, rather than a walk in doc, she told me that it had probably been viral the whole time, that I didn't need the drops, but that by using the drops all the time I had obliterated any good bacteria too.

She also told me to look at it this way: if I wake up with puss/crusties and clear them and they don't return within an hour it isn't worth drops. If the puss/weapingcrusties return within an hour or two, get the drops. In all my cases of pink eye (MANY), it has only been that bad once.

[rugbywife]

I think it is also worth pointing out that, really, pink eye is just a lay term meant to indicate an eye infection/flare up of some type, and clearly one's eyes could be red for many reasons, hence why there are different treatments for different situations. Presuming antibiotic drops are needed is just silly.

[babyrn]

When I was in nursing school we were taught that it is usually viral but it is almost impossible to tell the difference between viral and bacterial so antibiotics are often prescribed "just in case". I think a big part of the problem is that a lot of daycares/schools will not allow the kid back until they have been on drops for over 24 hours. My job is the same way.

[Deleted]

May 14, 2014 13:29:15 GMT -5 babyrn said:

When I was in nursing school we were taught that it is usually viral but it is almost impossible to tell the difference between viral and bacterial so antibiotics are often prescribed "just in case". I think a big part of the problem is that a lot of daycares/schools will not allow the kid back until they have been on drops for over 24 hours. My job is the same way.

Exactly. Plus, parents don't listen to their doctor and go to someone who will give them what they want. Then their kid gets better (when they would have anyway) and parents think it was the drops when it was just the natural course of the virus. Parents then think their doc is a quack and just decide to keep going to the overprescribing NP at urgent care. 

It is a huge pet peeve of mine, but our "I want it now and my way" culture is really screwing us in terms of antibiotic resistance. The vast majority of prescribed antibiotics are unnecessary, but people demand them because they don't WANT to wait it out. Docs are put in a tough spot between doing what is right and making patients mad/think they are a quack because they won't do what the guy down the street will.

[greencrayon]

May 14, 2014 10:24:46 GMT -5 @fivedogs said:

It's often viral, but kids tend to rub their dirty hands in their eyes and give themselves secondary bacterial infections.

My kids have also gotten goopy, reddish eyes along with a cold, probably from the same virus causing the cold. That cleared up along with the cold.

I would not keep her out of daycare for a week. AAP says no need to exclude from childcare unless they have a fever or can't participate in activities. It's like a cold.

www.healthychildcare.org/pdf/infdiseases/m3_pinkeye.pdf

This is what I have heard. The doctors prescribe the eye drops for a secondary bacterial infection, but the cause was likely viral. 

[drloretta]

Question: antibiotic drops for viral conjunctivitis wouldn't have helped, correct? She went from mild redness and goop on Monday to eyes glued shut and deep red on Tuesday evening (despite treating with artificial tears), which is when I decided she should be re-evaluated. Now I feel like I'm justifying myself to the naysayers, LOL.

[elcjet]

May 14, 2014 15:41:22 GMT -5 drloretta said:

Question: antibiotic drops for viral conjunctivitis wouldn't have helped, correct? She went from mild redness and goop on Monday to eyes glued shut and deep red on Tuesday evening (despite treating with artificial tears), which is when I decided she should be re-evaluated. Now I feel like I'm justifying myself to the naysayers, LOL.

I agree with PP, don't justify the damn drops.  They worked!  You are a working woman -- you can't sit home for a week with a kid who has a damn goopy eye when next week they could have Hand Foot & Mouth!  Gotta prioritize that PTO.

[anna7602]

We've done it both ways. Our homeopathic pedi in France reco'd some kind of ocular eyewash (sorry if I am butchering my translation of the French term) as a litmus test. If her eyes cleared up after using that once or twice, then we were good to go. If they didn't, then we went on to Rx drops. 

Our pedi here does the "amount of gunk" test. If her eyes are screwed shut by the amount of gunk coming out of them, then we get Rx drops. If they just look irritated and slightly runny, then we ride it out and use cold wash cloths on her eyes, still meticulously launder the sheets & etc., but it usually resolves itself in a couple of days. 

[rikki]

When I was in high school I had the bright idea of putting soap in my eye, going to the office and claiming I had pink eye. It left my eye really red and watery just long enough to make it to my car and promptly cleared up by the time I got to the mall.